I 

116TH CONGRESS 

1ST SESSION H. R. 2951 

To amend title XVIII of the Social Security Act to provide for coverage 

of dental services under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 23, 2019 

Ms. BARRAGA ́N (for herself and Ms. KELLY of Illinois) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for coverage of dental services under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Dental Ben5 efit Act of 2019’’. 


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1 SEC. 2. COVERAGE OF DENTAL SERVICES UNDER THE 

2 MEDICARE PROGRAM. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) in subparagraph (GG), by striking ‘‘and’’ at 

6 the end; 

7 (2) in subparagraph (HH), by striking the pe8 riod at the end and inserting ‘‘; and’’; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(II) dental and oral health services (as defined 

12 in subsection (kkk));’’. 

13 (b) DENTAL AND ORAL HEALTH SERVICES DE14 FINED.—Section 1861 of the Social Security Act (42 

15 U.S.C. 1395x) is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘Dental and Oral Health Services 

18 ‘‘(kkk) The term ‘dental and oral health services’ 

19 means services (as defined by the Secretary) that are nec20 essary to prevent disease and promote oral health, restore 

21 oral structures to health and function, and treat emer22 gency conditions, including— 

23 ‘‘(1) routine diagnostic and preventive care 

24 such as dental cleanings, exams, and x-rays; 

25 ‘‘(2) basic dental services such as fillings and 

26 extractions; 


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1 ‘‘(3) major dental services such as root canals, 

2 crowns, and dentures; 

3 ‘‘(4) emergency dental care; and 

4 ‘‘(5) other necessary services related to dental 

5 and oral health (as defined by the Secretary).’’. 

6 (c) COVERAGE OF ROUTINE DIAGNOSTIC AND PRE7 VENTIVE CARE AS A PREVENTIVE SERVICE.—Section 

8 1861(ddd)(3) of the Social Security Act (42 U.S.C. 

9 1395x(ddd)(3)) is amended by adding at the end the fol10 lowing new subparagraph: 

11 ‘‘(D) Dental and oral health services described 

12 in paragraph (1) of subsection (kkk), relating to 

13 routine diagnostic and preventive care.’’. 

14 (d) PAYMENT; COINSURANCE; AND LIMITATIONS.— 

15 (1) IN GENERAL.—Section 1833(a)(1) of the 

16 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

17 amended— 

18 (A) by striking ‘‘and’’ before ‘‘(CC)’’; and 

19 (B) by inserting before the semicolon at 

20 the end the following: ‘‘, and (DD) with respect 

21 to dental and oral health services (as defined in 

22 section 1861(kkk), other than those services de23 scribed in paragraph (1) of such section), the 

24 amount paid shall be the payment amount spec25 ified under section 1834(v)’’. 


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1 (2) PAYMENT AND LIMITS SPECIFIED.—Section 

2 1834 of the Social Security Act (42 U.S.C. 1395m) 

3 is amended by adding at the end the following new 

4 subsection: 

5 ‘‘(v) PAYMENT AND LIMITS FOR DENTAL AND ORAL

6 HEALTH SERVICES.— 

7 ‘‘(1) IN GENERAL.—The payment amount 

8 under this part for dental and oral health services 

9 (as defined in section 1861(kkk), other than those 

10 services described in paragraph (1) of such section) 

11 shall be, subject to paragraph (3), the applicable 

12 percentage (specified in paragraph (2)) of the lesser 

13 of the actual charge for the services or the amount 

14 determined under the payment basis determined 

15 under section 1848. 

16 ‘‘(2) APPLICABLE PERCENTAGE.—For purposes 

17 of paragraph (1), the applicable percentage specified 

18 in this paragraph is— 

19 ‘‘(A) for the first year beginning at least 6 

20 months after the date of the enactment of this 

21 subsection, 0 percent; 

22 ‘‘(B) for the year following the year speci23 fied in subparagraph (A) and each subsequent 

24 year through the seventh year following the 

25 year specified in subparagraph (A), the applicaVerDate Sep 11 2014 23:19 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2951.IH H2951

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1 ble percent specified in this paragraph for the 

2 previous year increased by 10 percentage 

3 points; and 

4 ‘‘(C) for the eighth year following the year 

5 specified in subparagraph (A) and each subse6 quent year, 80 percent. 

7 ‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR8 ITY.— 

9 ‘‘(A) FREQUENCY.—With respect to dental 

10 and oral health services that are— 

11 ‘‘(i) routine dental cleanings, payment 

12 may be made under this part for only two 

13 such cleanings during a 12-month period; 

14 and 

15 ‘‘(ii) routine exams, payment may be 

16 made under this part for only two such 

17 exams during a 12-month period. 

18 ‘‘(B) SECRETARIAL AUTHORITY.— 

19 ‘‘(i) AUTHORITY TO APPLY ADDI20 TIONAL LIMITATIONS.—The Secretary may 

21 apply such other reasonable limitations on 

22 the extent to which dental and oral services 

23 are covered under this part, including 

24 through application of a prior authoriza25 tion requirement. 


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1 ‘‘(ii) AUTHORITY TO MODIFY COV2 ERAGE.—Notwithstanding any other provi3 sion of this title, if the Secretary deter4 mines appropriate, the Secretary may mod5 ify the coverage under this part of dental 

6 and oral health services to the extent that 

7 such modification is consistent with the 

8 recommendations of the United States Pre9 ventive Services Task Force.’’. 

10 (e) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

11 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 

12 1395w–4(j)(3)) is amended by striking ‘‘risk assessment) 

13 ,’’ and inserting ‘‘risk assessment), (2)(II),’’. 

14 (f) DENTAL PROSTHESES.— 

15 (1) IN GENERAL.—Section 1861(s)(8) of the 

16 Social Security Act (42 U.S.C. 1395x(s)(8)) is 

17 amended— 

18 (A) by striking ‘‘(other than dental)’’ and 

19 inserting ‘‘(including dental)’’; and 

20 (B) by striking ‘‘internal body’’. 

21 (2) SPECIAL PAYMENT RULES.—Section 

22 1834(a) of the Social Security Act (42 U.S.C. 

23 1395m(a)) is amended by adding at the end the fol24 lowing new paragraph: 


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1 ‘‘(23) PAYMENT AND LIMITS FOR DENTAL

2 PROSTHESES.— 

3 ‘‘(A) IN GENERAL.—The payment amount 

4 under this part for dental prostheses shall be, 

5 subject to subparagraph (C), the applicable per6 cent (specified in subparagraph (B)) of the 

7 amount otherwise payable for such dental pros8 theses under this section. 

9 ‘‘(B) APPLICABLE PERCENT.—For pur10 poses of subparagraph (A), the applicable per11 cent specified in this subparagraph is— 

12 ‘‘(i) for the first year beginning at 

13 least 6 months after the date of the enact14 ment of this paragraph, 0 percent; 

15 ‘‘(ii) for the year following the year 

16 specified in clause (i) and each subsequent 

17 year through the seventh year following the 

18 year specified in clause (i), the applicable 

19 percent specified in this subparagraph for 

20 the previous year increased by 10 percent21 age points; and 

22 ‘‘(iii) for the eighth year following the 

23 year specified in clause (i) and each subse24 quent year, 80 percent. 


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1 ‘‘(C) LIMITATIONS AND SECRETARIAL AU2 THORITY.— 

3 ‘‘(i) IN GENERAL.—Payment may be 

4 made under this part for an individual 

5 for— 

6 ‘‘(I) not more than one full upper 

7 and one full lower dental prostheses 

8 once every five years; and 

9 ‘‘(II) not more than one partial 

10 upper dental prostheses and one par11 tial lower dental prostheses once every 

12 five years. 

13 ‘‘(ii) SECRETARIAL AUTHORITY.— 

14 ‘‘(I) AUTHORITY TO APPLY ADDI15 TIONAL LIMITATIONS.—The Secretary 

16 may apply such other reasonable limi17 tations on the extent to which dental 

18 prostheses are covered under this 

19 part, including through application of 

20 a prior authorization requirement. 

21 ‘‘(II) AUTHORITY TO MODIFY

22 COVERAGE.—Notwithstanding any 

23 other provision of this title, if the Sec24 retary determines appropriate, the 

25 Secretary may modify the coverage 


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1 under this part of dental prostheses to 

2 the extent that such modification is 

3 consistent with the recommendations 

4 of the United States Preventive Serv5 ices Task Force.’’. 

6 (g) REPEAL OF GROUND FOR EXCLUSION.—Section 

7 1862(a) of the Social Security Act (42 U.S.C. 1395y) is 

8 amended by striking paragraph (12). 

9 (h) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to services furnished on or after 

11 January 1, 2020. 

Æ 


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